The problems that bother him most are -
- Social anxiety and isolation - the need to work on this in the lead up to University entry in September so he can successfully integrate with other students / room mates.
- Calorie counting - Ben is still counting calories to ensure he has sufficient food to keep his weight up but not overeat (see below). For a year or so he has been successfully consuming 2400 calories a day which has led to a very gradual weight gain to his present weight of 60kg, but anything over and above this would be very difficult to come to terms with.
- Weight - he still has problems with the idea of increasing his weight over and above 60kg (BMI 21); a fear of getting 'fat'. CAMHS were insistent that his present weight / BMI is OK (a weight "he feels happy with and can cope with"...)
- Bingeing - a fear that he no longer has the mechanism that tells him when to stop eating; fear that he will get obese as a result - counting calories is a way of controlling this.
- Social eating - although the odd meal out with or prepared by friends is manageable, in theory, anything more than that isn't i.e. he would find it very stressful to not be in control of his own meal preparation. He also finds it stressful to eat with friends and anyone with 'annoying habits' (e.g. people that overeat or under eat, play with their food, etc) exacerbates this.
Just to recap... Ben's background is that he was plump, introvert and bullied as a pre-teen, but became very athletic, sporty and popular as a teenager. This led to the belief that being popular = being athletic and good at sport.
As he started to dislike sport more and more he discovered that, by eating less and eating diet foods, he could maintain his physique without having to do as much sport. However, in reality, he was doing more exercising than ever while cutting down on food and developing all the tell-tale signs like ritualistic eating, low mood, social isolation, etc.
Over the summer of 2009 he lost one third of his body weight and the eating disorder 'kicked in' big-style with ED rages, frightening behaviour, suicidal thinking, school phobia, etc. He didn't start CAMHS treatment until Feb 2010 (long waiting list) by which time he had plummeted down hill in every way.
After an initial rigorous re-feeding programme where he reached 60kg, he refused to cooperate any longer. This was followed by a significant weight loss, mood deterioration, temporary removal from school (he is still only back at school part-time), etc.
In October 2010 following a second hospital admission for Bradycardia and the threat of IP admission, he turned a corner and - between then and now - we have worked together, along with the CAMHS psychiatrist, on gaining weight and changing his mindset, assisted by a course of Prozac.
Although his recovery has come on leaps and bounds there are still a few 'loose ends' that need tying up in order for him to live a normal and happy life, as outlined above.
So watch this space to see if this therapist might be able to help - and if Ben will be happy to see her.